Background: Despite good progress in the management of patients with atrial fibrillation, this arrhythmia remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity in the world. Furthermore, the number of patients with AF is predicted to rise steeply in the coming years.
Objective: To validate a clinical risk stratification tool (AF-CVS score) for identifying patients at high risk for unsuccessful outcome after electrical cardio-version for acute AF.
Patients and Methods: The present study was a cohort study conducted between March 2018 and March 2019. We enrolled 100 consecutive patients admitted at Al-Hussain University, Al-Azhar University, presented with acute onset atrial fibrillation (AF) requiring direct current electro-version (DC electro-version). An informed consent obtained from every patient after full explanation of the research objectives and the purpose of this study.
Results: A binary logistic regression was run to evaluate AFCVS score as a predictor for the recurrence among the patients in the study population. There was homoscedasticity and normality of the residuals. The binary logistic regression model was statistically significant (χ2= 28.01, df 1, p= < 0.001) with insignificant Hosmer and Lemeshow test (p 0.114). AFCVS score was a significant predictor for the AF recurrence in the studied population (p < 0.001). The diagnostic efficacy and cut off point of AFCVS for prediction of AF recurrence in the studied sample was determined using a receiver operating characteristic curve (ROC) and the AFCVS score cut off point was 5 . The score showed 83.8% sensitivity, 68.3% Specificity, 87.8% negative predictive value, 60.8% positive predictive value and 74% accuracy.
Conclusion: Atrial fibrillation provokes important economic burden along with significant morbidity and mortality. Our study showed that the risk of unsuccessful outcome of ECV can be predicted using five simple clinical variables: A-- Age. F-- not First time AF. C-- Cardiac failure. V-- Vascular disease. S-- Short duration from previous AF (within 1 month before electrical cardio-version (ECV)).